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Change Agent Training. Day 1. Objectives of the course. Apply the Lean methodology to the workplace Apply practical principles through simulations Use knowledge gained to develop a Lean investigation in your own area Provide a network of support for each other. Agenda.
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Change Agent Training Day 1
Objectives of the course • Apply the Lean methodology to the workplace • Apply practical principles through simulations • Use knowledge gained to develop a Lean investigation in your own area • Provide a network of support for each other
Agenda 09:15 Lean Simulation 10:30 Coffee 11:15 Transformation Approach Parts 1 and 2 12:00 Lunch 12:45 Transformation Approach Part 3 14:00 Coffee 16:30 Close
Reflection from Half Day Session • Any thoughts you’d like to share with the group?
Lean Flow Game Game Number 1!
Learning Points from Flow Game • Types of ‘Waste’ what were they? • Transportation • Waiting • Re-work • Motion • Kanban • Flow • Value Stream • Single Piece Flow – no batching
1. Preparation • Voice of the Customer • Defining Value • Project Scoping
Voice of the Customer “Lean thinking …must start with a conscious attempt to precisely define value…. Through a dialogue with customers” James P. Womack & Daniel T. Jones
Who are the customers? • Who are the users of the service.. • people upstream and downstream of you that receive what you deliver (patients are our customers) • payers/manager of the services provide the Voice of the Business • VoC and VoB can give rise to conflicting requirements • Can you identify your customers? • How would you identify what ‘value’ means for your customer?
Project Scoping • A Project Charter is a simple tool for formalising the nature and boundaries of the project. • It allows clear communication to all project team members and stakeholders. • No matter how small a project/idea its always good to draw up a project charter so everyone knows the scope
1. Preparation • Voice of the Customer • Defining Value • Project Scoping
2. Value Stream Analysis • Data Collection • Pareto Analysis • 5 Whys • Value Stream Mapping (process mapping)
Data Collection • Before you start any project you must look at where you are now i.e. baseline measurement • What data do I need, where do I start?
Pareto Principle (80/20 rule) • Italian economist Vilfredo Pareto observed that for many events, roughly 80% of the effects come from 20% of the causes • in 1906 he found that 80% of the land in Italy was owned by 20% of the population • Pareto analysis is a very simple technique that helps you to focus efforts on the problems that offer the greatest potential for improvement.
Pareto Principle • Pareto's principle, the 80/20 rule, should serve as a daily reminder to focus your time and energy on the issues that really make a difference. • 80 per cent of a nurse's time is spent on 20 per cent of the patients • 80 per cent of the decisions made in meetings come from 20 per cent of the meeting time
When to use Pareto? • A Pareto Chart breaks a big problem down into smaller pieces, identifies the most significant factors, shows where to focus efforts, and allows better use of limited resources • A Pareto Chart is a good tool to use when the process you are investigating produces data that are broken down into categories • A Pareto diagram puts data in a hierarchical order, which allows the most significant problems to be corrected first.
Pareto Chart • Exercise 1 Draw a Pareto Chart
Analysing the Data • Ask the 5 whys • 1. Why do TTAs take a long time to get to the ward? • Because pharmacy don’t get the list of TTAs in time for discharge • 2. Why? • Because doctors don’t order the TTAs in time • 3. Why? • They batch them up and do them at the end of the day • 4.Why? • TTA pads are at the nursing station and not used during the ward round • 5. Why? • Because it’s always been done that way
Value Stream “Wherever there is a product or service for a customer, there is a value stream. The challenge lies in seeing it”
Value Stream Mapping • What is Value? In NHS terms – Value is any activity which improves the patient’s health, well being and experience • Why Value Stream? Identifies the core set of actions required to deliver value for patients • Why Value Stream Analysis? To align healthcare processes to facilitate the smooth flow or patients and information Eliminate stop – starts and identify ‘hand-offs’
Value Stream Mapping Exercise • You are an event organiser and have been asked to organise a picnic for 10 clients in a week’s time. • This is the first time you’ve organised a picnic so you want to document the current state (what happens now) and test out the process with this client. • Start of value stream: Client requests the picnic • End of value stream: Deliver picnic to venue
Value Stream Mapping Analysis • Step 2 Once you’ve mapped the process identify the following; • Who is the customer? • Identify the value added and non value added steps for the customer • What’s the elapsed time? Min and max • What’s the value added time?
2. Value Stream Analysis • Data Collection • Pareto Analysis • 5 Whys • Value Stream Mapping (process mapping)
3. Identify Constraints • Identify Bottlenecks • Root Cause Analysis • Variation
Introduction to Variation • The extent or degree to which something varies • Too much variation in the workplace introduces risk, so reducing variation reduces risk. • E.g. introduction of the Theatre WHO checklist • The variance is a measure of how far a set of numbers are spread out.
Variation Exercise • Airplanes!
Reducing Variation • Can you see variation in your work place? • How could you use the airplane principles to identify variation in your workplace? E.g. what could you measure • To understand variation in more detail you can use the fish bone tool
Root Cause Analysis Method Man Materials Problem Statement: Mother Nature Machine/ Technology Measurement
Root Cause Analysis Method Man Materials Standardised operating instructions One person throwing all planes Different throwing techniques Height and strength Different paper/texture/size Same size paper Problem Statement: Variation in distance travelled by aeroplane Not clear what we were measuring Could we have used technology in this process Technology to be investigated Air pressure of room Measure and scale agreed in advance Maintain temperature Mother Nature Machine/ Technology Measurement
3. Identify Constraints • Identify Bottlenecks • Variation • Root Cause Analysis
Human Dimensions of Change • Circle of influence • Role of a Change Agent • Killer Phrases • Belbin
What is a change agent? • Facilitator • Continuous Improvement facilitator • Service Improvement facilitator • Champion of Change • Internal or Lean Champion • Other?
What is a change agent? • A person within an organisation who has the requisite knowledge, skills, desire and motivation to make improvements happen through change • Usually not in a position of authority within the areas of the organisation over which they make these improvements happen • Someone who achieves improvement results with and through other organisational members and stakeholders
Planning your project • Spend the next 20 minutes thinking about your next steps • Use the project charter template to think about a problem and the desired solution • If you have already started a project think about which lean tools you might apply to the project
Change Agent Training Day 2
Waste Walk • In pairs visit each others department and observe. • Note any of the 7 wastes using the waste template • When you introduce yourself to the department please say that you are observing the process not the people
4. Future State • Other Problem Solving Techniques • Ideal Future State • Future State Map
Exercise • Draw a spaghetti diagram for round 1
